1.
Temporary Insurance Identification Card
Automobile Club Inter-Insurance Exchange (NAIC #15512)
12901 North Forty Dr., St. Louis, MO 63141 THIS CARD MUST BE CARRIED IN THE INSURED
MOTOR VEHICLE FOR PRODUCTION UPON DEMAND.
Policy Number: A10334951
IN CASE OF AN ACCIDENT
Effective Date: 02/16/2012 Expiration Date: 04/16/2012
Report any accident immediately to:
Year: 2010 Make / Model: KIA OPTIMA SED
Claims
VIN#: KNAGG4A86A5394482
1–866–222–2378
Insured: Calvin L Carr , Debra K Carr
Examine your policy carefully. This form does not
Address: 680 SE Highway EE constitute any part of your insurance policy.
Leeton, MO 64761
THIS CARD IS VOID 60 DAYS FROM THE EFFECTIVE DATE
SHOWN. SEE IMPORTANT NOTICE ON REVERSE SIDE.
Form #199 (12/2009)
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l
Fold Here
Temporary Insurance Identification Card
Automobile Club Inter-Insurance Exchange (NAIC #15512)
12901 North Forty Dr., St. Louis, MO 63141 THIS CARD MUST BE CARRIED IN THE INSURED
MOTOR VEHICLE FOR PRODUCTION UPON DEMAND.
Policy Number: A10334951
IN CASE OF AN ACCIDENT
Effective Date: 02/16/2012 Expiration Date: 04/16/2012
Report any accident immediately to:
Year: 2001 Make / Model: CHEV C-1500
Claims
VIN#: 1GCEC14T41E199906
1–866–222–2378
Insured: Calvin L Carr , Debra K Carr
Examine your policy carefully. This form does not
Address: 680 SE Highway EE constitute any part of your insurance policy.
Leeton, MO 64761
THIS CARD IS VOID 60 DAYS FROM THE EFFECTIVE DATE
SHOWN. SEE IMPORTANT NOTICE ON REVERSE SIDE.
Form #199 (12/2009)
^
l
Fold Here